RELEVANT PROGNOSTIC FACTORS IN GASTRIC-CANCER - 10-YEAR RESULTS OF THE GERMAN GASTRIC-CANCER STUDY

Objective In 1986 a prospective multicenter observation trial in patie nts with resected gastric cancer was initiated in Germany. An analysis of prognostic factors based on the 10-year survival data is now prese nted. Patients and Methods A total of 1654 patients treated for gastri c cancer between 1986 and 1989 at 19 centers in Germany and Austria we re included. The resected specimen were evaluated histopathologically according to a standardized protocol. The extent of lymphadenectomy wa s classified after surgery based on the number of removed lymph nodes on histopathologic assessment (25 or fewer removed nodes, D1 or standa rd lymphadenectomy; >25 removed nodes, D2 or extended lymphadenectomy) . Endpoint of the study was death. Follow-up is complete for 97% of th e included patients (median follow-up of the surviving patients is 8.4 years). Prognostic factors were assessed by multivariate analysis. Re sults A complete macroscopic and microscopic tumor resection (RO resec tion according to the UICC 1997) could be achieved in 1182 of the 1654 patients (71.5%). The calculated 10-year survival rate in the entire patient population was 26.3% +/- 4.7%; it was 36.1% +/- 1.6% after an R0 resection. In the total patient population there was an independent prognostic effect of the ratio between invaded and removed lymph node s, the residual tumor (R) category, the pT category, the presence of p ostsurgical complications, and the presence of distant metastases. Mul tivariate analysis in the subgroup of patients who had a UICC RO resec tion confirmed the nodal status, the pT category, and the presence of postsurgical complications as the major independent prognostic factors . The extent of lymph node dissection had a significant and independen t effect on the 10-year survival rate in patients with stage II tumors . This effect was present in the subgroups with (pT2N1) and without (p T3N0) lymph node metastases on standard histopathologic assessment. Th e beneficial effect of extended lymph node dissection for stage II tum ors persisted when patients with insufficient lymph node dissection (< 15 nodes) were excluded from the analysis. There was no difference in the postsurgical morbidity and mortality rates between patients with s tandard and extended lymph node dissection. Conclusions Lymph node rat io and lymph node status are the most important prognostic factors in patients with resected gastric cancer. In experienced centers, extende d lymph node dissection does not increase the mortality or morbidity r ate of resection for gastric cancer but markedly improves long-term su rvival in patients with stage ii tumors. This effect appears to be ind ependent of the phenomenon of stage migration.